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Cognitive behavioral therapy (CBT) is an approach that works with an individual to alter their belief structures about a situation. The approach has been shown to improve outcomes for people with chronic pain.

For people with chronic pain, CBT can:

• Improve vocational outcomes; and
• Remove perceived barriers to return to work; and
• Remove perceived barriers to an increase in working hours.

The START or "selected targets of activity retraining program" was undertaken at the St. Vincent’s Hospital Center in Melbourne.

Why the research matters

Patients with long term chronic pain are a difficult group to treat and there are limited effective options. CBT has been shown to be effective, but there is limited research on this topic.

The researchers in this study evaluated a group of patients who had undergone CBT, and assessed the physical and psychological outcomes, in particular on depression, anxiety and stress, as well as self-efficacy and disability.

What the research involved  

360 patients who went through the START CBT program between 1998 and 2005 were asked to complete a vocational survey. 58% participated.
The START program requires full time attendance for three weeks, followed by a four week home or work program with follow-up at one, six, and twelve months. The program was run by a multidisciplinary team with psychologists, physiotherapists and pain management specialists. The program is aimed at teaching individuals strategies that will assist them to resume a normal life despite their pain.

Summary of research findings 

The average duration of pain was over 8 years and half of the people going through the program reported pain in more than three areas. The most common cause of pain was an accident, many of these work or motor vehicle related.
Before they underwent the CBT program, 90% of participants indicated that their chronic pain was a barrier to return to work.
At the time of the assessment 35% were working in paid or unpaid positions and 40% were unemployed. 80% of those out of work had been out of work for longer than 6 months.
After the program there was a significant reduction in the number of participants who reported pain as a barrier to returning to work or increasing their hours of work.

Significant improvement was seen across the reported physical and psychological measures for those involved with the study, and this included follow-up at six and twelve months.
After the program 50% of the population moved closer to working full time.
The study has some limitations in that it evaluated people after the program, and did not have a control group, that is a group who were evaluated at the same time who did not go through the program.

Original research 

The vocational continuum: how to make sense of vocational outcomes after group cognitive behavioural therapy for chronic pain sufferers.
White DC, Beecham R, Kirkwood K.
J Occup Rehabil. 2008 Sep;18(3):307-17. Epub 2008 Jun 28.

Link to PubMed abstract